Provider First Line Business Practice Location Address:
1011 W SABINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75633-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-223-1118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007